This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

Saturday, June 25, 2011

Weekly Overseas Health IT Links - 25 June, 2011.

Note: Each link is followed by a title and a paragraph or two. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

WASHINGTON – Even doctors who have purchased and successfully implemented electronic health records (EHRs) do not always know what they’re buying until the system is up and running.

ONC director Farzad Mostashari made that point to a room full of chuckles on Wednesday while giving the closing keynote address at the Government Health IT Conference here in Washington.

The problem: While there are nearly 750 EHR products certified for meaningful use stage 1, adequate apples-to-apples comparisons of features and prices do not exist today.

Competition is a wonderful thing, said Mostashari, but “classic causes of market failure,” in this instance prohibitively high switching costs, vendor or data lock-in, among others, weaken the competitive landscape.

“We need to create a better marketplace,” he said. “We want as little government involvement as possible, but no less.”

The promise is enormous. Patients could take control of copies of their own personal health histories. Referring doctors could easily communicate with one another about a patient’s treatment. Diagnoses could benefit from historical information about every ailment you’ve had since you were a kid.

EMR is a part of healthcare information technology that is used to make paperless computerized patient data in order to increase efficiency of hospital systems and reduce chances of errors in medical records. A substantial growth rate (more than 16%) of the U.S. healthcare IT spending and the government initiatives towards development of a nationwide healthcare information network are expected to push EMR implementation across the healthcare sector in the U.S. The rising demand for the healthcare cost containment and need to improve the quality of healthcare service are driving the growth of the EMR market in the U.S. The U.S. EMR market is expected to grow from $2,177 million in 2009 to $6,054 million in 2015 at an estimated CAGR of 18.1% during the forecast period 2010-2015.

ScienceDaily (June 16, 2011) — Canadian privacy experts have issued a new report on June 16 that strongly backs the practice of de-identification as a key element in the protection of personal information. The joint paper from Ontario's Information and Privacy Commissioner, Dr. Ann Cavoukian, and Dr. Khaled El Emam, the Canada Research Chair in Electronic Health Information at the University of Ottawa and the Children's Hospital of Eastern Ontario Research Institute, comes as some privacy policy makers increasingly question the value of de-identification

Personal information can be routinely de-identified before it is used or disclosed for a wide range of purposes, such as research, where it is not necessary to know the identity of individuals. Recently, however, the practice of de-identification as an effective tool to protect privacy has been challenged by those who claim it is possible to re-identify individuals from seemingly anonymous data. The new report refutes this position, and further validates that anonymizing data is a reliable, safe and practical way to protect personal information.

Implementing a clinical health information technology system seems to have little effect on health outcomes for nursing-home residents, according to new research.

In a study—the results of which are published online in the Journal of Aging and Health—researchers assessed 761 nursing-home residents in the New York City area. The researchers found that health IT had no statistically significant impact on residents' clinical or functional outcomes, with one exception: There was a negative effect on residents' behavioral symptoms. Researchers observed more disruptive behavior among residents in nursing homes that had health IT systems in place. The investigators emphasized that more research was needed to understand whether such a relationship actually exists and what the mechanism is behind it.

An online survey in May of 3,800 physician members of the QuantiaMD online physician community finds their use of mobile devices rapidly growing, with a quarter of respondents being "Super Mobile" users who have a smart phone and tablet device.

The use of tablet devices among responding physicians exceeds 30 percent, with 19 percent using tablets in clinical settings. In total, 83 percent of respondents own at least one mobile device and 44 percent of those who don't intend to get one this year.

In the 10 years since the eHealth Initiative was established, we have witnessed unparalleled growth and enthusiasm for health IT solutions. The progress we have made is undeniable.

Over the last decade, the number of health information exchange initiatives grew from a couple dozen to more than 250. We have witnessed three national coordinators for health IT lead the industry in different and significant ways. Most importantly, we have seen a dramatic uptick in electronic health record adoption levels from single digits in 2001 to nearly a quarter of clinicians now using EHRs.

MPs have waded into a debate about the state of the NHS computer systems.

And although there have been no changes suggested at the moment, MPs have brought upsome interesting points surrounding failures and escalating costs.

The first speech came from Richard Bacon, a Conservative MP for South Norfolk who began the debate by talking about the national programme for IT in the health service. He said it was the "largest civilian computer project in the world" and was "spawned in late 2001 and early 2002." by then Prime Minister, Tony Blair. He had a little tete a tete with Bill Gates and was "bowled over" by a vision of what IT could do to transform the economy and health service.

The idea was for information to be captured once and used many times, transforming working processes and speeding up communications.

An analysis of diabetes care in the greater Cleveland region shows 51 percent of diabetic patients treated at facilities with an electronic health record received all needed care, compared with 7 percent treated at paper-based facilities.

"A similar variation was also reported for diabetes patient outcomes--how well patients and their doctors were able to effectively manage their condition," according to a brief of results from the Robert Wood Johnson Foundation. "For both care and outcomes, patients treated at practices with EHRs far outpaced those in paper practices across all insurance types--whether patients were on Medicare, Medicaid, a commercial plan or uninsured."

Here's a reader challenge: I'll pay $10 to the first adult who has had at least five encounters with the private-sector healthcare system in the past 10 years to come up with a complete map of where all his or her electronic health records have traveled, who has seen them and where they are now.

I feel my money is safe in my pocket, and here's why:

First, I've been covering health IT for nearly 11 years, and there is no system I know in this country that can completely track the whereabouts of someone's electronic health information.

PORTLAND, ME – The opt-in legislation for Maine’s health information exchange was met with “clear opposition” by providers throughout the state, but a revised version that is pending the governor’s approval would make it a mandate that providers who are participating in the HIE provide their patients with a separate form to opt-out.

Amy Landry, communications manager, at HealthInfoNet, Maine’s health information exchange, wants to clear the air when it comes to the legislation. She said that some reports have “made it sound like we [HealthInfoNet] suddenly chose an opt-out model. We were already an opt-out and have always been operating as an opt-out, “she says.

Health insurers are hitching a ride into the physician office -- and the exam room -- on patients' smartphones.

Some of the largest health plans have developed mobile apps that will give a member access to information from his or her insurer, including drug prices and a network directory. Coming soon will be apps aimed at physicians themselves.

Health plans see mobile technology as a convenient customer service portal, a cost-cutting tool and a way to break down the traditional barriers between physician, patient and health plan. Humana's myHumana app identifies out-of-pocket drug costs for a given prescription, available to a member from his or her smartphone. Health Net's mobile app lists claims history. Several apps can display health savings account balances.

A bill working its way through the state Legislature would make it more difficult for health care providers to modify or delete electronic medical records and leave no record of the change.

“Changes to an EHR (electronic health record) can go unnoticed and can be harder to trace than changes made to paper records,” said Sen. Mark Leno, D-San Francisco, the author of SB 850, in a hearing last month. The bill passed the Senate on May 31. It will be heard in the Assembly's Health and Judiciary committees in the next few weeks.

Supporters of the bill point to the case of Diane Stewart, a woman who died suddenly following a knee operation at the Stanford University Medical Center a few years ago, as evidence of why such measures are needed. Investigators at the state Department of Public Health found that relevant portions of Stewart's computer file had been erased after her death and that a nurse was instructed to make postmortem entries to describe her care. Stewart's family alleged that hospital employees tried to cover up their error. The hospital has denied any wrongdoing in the case, according to Hearst Newspapers.

WASHINGTON – As the healthcare system becomes more connected, it will increasingly become a breeding ground for risk to individual privacy, confidential information, data integrity and service availability, according to health IT security experts.

That’s why establishing trust is the “essential enabler” for the adoption of electronic health records, said Dixie Baker, SAIC senior vice president and chief technology officer for health solutions. She is also chair of the advisory Health IT Standards Committee’s privacy and security work group.

“It’s not that we’re just trying to keep the information from going where it shouldn’t go. It’s also essential that we make sure that the information goes where it is needed. Both of those are necessary to build that trust in consumers,” she said June 14 at the Government Health IT Conference & Exhibition hosted by the Healthcare Information and Management Systems Society (HIMSS).

Sherlock Holmes would be proud of IBM's Watson computer. No longer the bumbling sidekick portrayed by Arthur Conan Doyle, the supercomputer has managed to master natural language skills, defeat Jeopardy contestants, and wow medical school professors with its potential to diagnose esoteric diseases. I suspect it would even make the late IBM President Thomas J. Watson, for whom the computer is named, proud.

Working with medical researchers at Columbia University, IBM is inputting data from medical textbooks and journals to create a diagnostic engine unlike any in the world. But it's likely we won't see a commercially available product for perhaps two more years.

Isabel Healthcare, on the other hand, has had an impressive, commercially available diagnostic tool up and running for many years and already has extensive research to show what it's capable of.

As researchers try to figure out whether health information technology (HIT) can improve quality of care, a study of 761 nursing home residents suggests that a comprehensive health IT system doesn't have any significant impact on health outcomes in this patient population.

There was "no measurable improvement in resident condition as a result of the HIT intervention. Therefore, claims that HIT in nursing homes will have direct benefits for residents should be tempered by the findings of this research," according to investigators from Weill Cornell Medical College, Columbia University Stroud Center, and the New York State Psychiatric Institute.

Primary care physicians like the idea that personal health records will make healthcare data more portable and open up communications channels with patients, but they still have plenty of questions about data security, workloads, and how PHRs might change their relationships with patients, a new study says.

According to the study, an online exclusive for the journal Canadian Family Physician, family physicians are interested in the general concept of PHRs, but the technology needs to be integrated with electronic health records, easy to use, and add value to family practice before doctors will consider bringing PHRs into their practices.

An Alabama woman has been charged with violations of the HIPAA privacy rule for stealing paper surgery schedules of about 4,500 patients from Trinity Medical Center in Birmingham and intending to use the names, dates of birth and Social Security numbers to commit identity theft.

Chelsea Catherine Stewart of Alabaster was charged in U.S. District Court under section 1320d-6 of the privacy rule, "Wrongful disclosure of individually identifiable health information." If convicted of taking the information with the intent to sell, transfer or use for commercial advantage, personal gain or malicious harm, she faces up 10 years in prison and a fine up to $250,000.

The Department of Health has said it will amend the Health and Social Care Bill to address concerns about confidentiality raised during the government’s ‘listening exercise.’

However, the Department’s response to the report of the Future Forum, led by GP Professor Steve Field, says further work will be needed before the changes can be announced.

A number of professional bodies, including the British Medical Association and the Royal College of GPs, raised concerns about clauses in the Bill that appear to give new powers to a range of organisations to demand information, and to require commissioning consortia to comply.

Gienna Shaw, for HealthLeaders Media , June 14, 2011

Technology might be to blame for growing obesity rates—think couch potatoes and hours of video gaming that doesn't involve jumping around with a Wii remote in your hand—but it could also help fight fat. Apps to track calories and weight loss or to "encourage" folks to lose weight have been around for a while (witness the parade of cute but not-so-sophisticated apps on the government-backed Apps for Healthy Kids. But healthcare professionals and researchers are working to take health and fitness apps to new levels—adding more sophisticated analytic capabilities and better functionality but also making them easier to use.

By BRONWYN GARRITY

On a chilly February night in Los Angeles, attendees at the DomainFest Global Conference crushed together in a tent at the Playboy Mansion for cocktails and dancing. Two days later, Nico Zeifang, a 28-year-old Internet entrepreneur from Germany, woke up with chest pains, chills and a soaring fever. Four colleagues shared his symptoms, Mr. Zeifang soon learned.

So he did what any young techie would: He logged on to Facebook and posted a status update. “Domainerflu count,” it said. “Who else caught the disease at D.F.G.?”

Within hours, 24 conference attendees from around the world added themselves to Mr. Zeifang’s Facebook list; within a week, the number climbed to 80. Many of them “friended” him to get information and to compare notes on their fevers and phlegmy coughs. Almost everyone, it seemed, had a theory about the source of the infection. Many suspected the artificial fog that permeated the tent.

Most countries, including the U.S., lack integrated online patient-record systems. Patients visiting new doctors need to fill out paper medical-history forms. What's more, over time, records can become spotty, incomplete, and difficult to access. This leads to both inefficiencies in the medical-record system, which cost money, and medical mistakes, which can cost lives.

Researchers and entrepreneurs hope to change that by giving each patient a smart card containing his or her complete medical history. This approach may prove difficult to implement in the U.S., owing to security fears and compatibility issues, but the technology has the potential to transform health care in countries that have unified health systems, or where there's inadequate infrastructure for sharing records in other ways.

Researchers in the U.K. have developed the MyCare card, which is roughly the size and shape of a credit card, with a fold-out USB plug. Another project, SmartCare, first implemented in Zambia, has recently expanded to Ethiopia and South Africa and demonstrates the potential for card-based systems in parts of the world with limited infrastructure.

The first thing Mike McCreary had to do was make sure his IT team in Joplin, Mo. was alive and well. After that came the daunting task of connecting a community left devastated and without power or phone lines from a near-record tornado to its vital medical data, past and present.

It has been almost three weeks since a deadly EF-5 tornado ripped through Joplin, and the scope of damage remains hard to comprehend.

When so little was going Joplin's way during the May 22 tornado that destroyed parts of the city, planning and a bit of good timing spared St. John's hospital from what might have been additional tragedy. In April, the Sisters of Mercy Health System, which includes St. John's Regional Medical Center destroyed in the storm, opened a state-of-the-art data center for mission critical applications and clinical data for its 28 acute care hospitals across a four-state region.

The new data center, in Washington, Mo. (and backed up at another location), is about 250 miles from Joplin and was unaffected by the violent weather. Three weeks before the tornado hit, St. John's went live on its scheduled switch to its new electronic health records system from Epic Systems Corp., the last major hospital in Mercy's system to do so.

Everywhere I turn, I hear about accountable care organizations, especially during provider-focused forums. Nearly everyone is excited about their ACO (and medical home) initiatives, but I’ve also met with quite a few skeptics who believe that the concept is nothing new and has been tried many times—and failed--in various forms. Interesting!

To be honest, I haven’t delved deeply into the complexities of the initiatives (but am doing a lot of research to come to grips with it) hence my blog today will be more of an invitation for comments rather than an opinionated monologue.

The government has decided to continue developing its CONNECT software, which links users to the National Health Information Network (NHIN) and can be downloaded for free by private health information exchanges. Several federal agencies also use the open-source software to exchange health data with one another and, in some cases, with private-sector entities.

The Office of the National Coordinator of Health IT (ONC) has contracted with CGI Federal Inc. to upgrade the federally funded software. The contract is worth $5.7 million in the first year, with possible one-year renewals. CGI will partner with Red Hat, best known for its Linux open-source operating system, which suggests that CGI will look for outside developers to help fix and enhance CONNECT.

The proliferation of health IT applications for providers and consumers will help drive national health spending to nearly 20 percent of GDP by 2019, a recent PriceWaterhouseCoopers (PwC) report predicts. Most of that cost increase, however--also forecast by Medicare actuaries in an October 2010 report published in Health Affairs--will not come from health IT, and it's even possible that growth in health IT adoption will start to bend the cost curve by the end of this decade.

According to the PwC report, entitled "The New Gold Rush," healthcare providers in 2010 spent $88.6 billion worldwide on health IT, including electronic health records and health information exchanges. It's unclear what percentage of that was in the U.S., but consulting firm Gartner previously had predicted that U.S. health IT spending would be $28.4 billion in 2009. Even if that figure rose significantly in 2010, it have would been a tiny fraction of the total U.S. health spending of $2.6 trillion. The HIT increase, similarly, would have been a small portion of the health cost growth of $127 billion from 2009 to 2010.

Margaret Dick Tocknell, for HealthLeaders Media , June 10, 2011

The Department of Health and Human Services has proposed a federal rule that would require hospitals, physicians, and health insurers to let patients know when their electronic medical records are accessed.

The rule would be a statutory requirement under the Health Information Technology for Economic and Clinical Health Act (HITECH). It would apply to any hospital, physician office, or health plan employees who have access to patient records.

Rather than study electronic health record (EHR) usability in the abstract, “a few high-value use cases, particularly those that have patient safety implications,” should be examined, according to recommendations developed by the HIT Policy Committee’s Adoption and Certification Workgroup.

Those recommendations — based on a day of hearings held by the workgroup — were outlined in a letter to National Coordinator Farzad Mostashari, M.D.

In the letter, authors Marc Probst, CIO at Intermountain Healthcare and co-chair of the workgroup, and Larry Wolf, senior consulting application/data architect at Kindred Healthcare and a workgroup member, broke down different facets of usability before suggesting the test-case approach.

Rather than study electronic health record (EHR) usability in the abstract, "a few high-value use cases, particularly those that have patient safety implications," should be examined, according to recommendations developed by the Health IT Policy Committee's adoption and certification workgroup.

Those recommendations--based on a day of hearings held by the workgroup--were outlined in a letter to national health IT coordinator Farzad Mostashari, MD.

In the letter, Marc Probst, CIO at Intermountain Healthcare and co-chair of the workgroup, and Larry Wolf, senior consulting application/data architect at Kindred Healthcare and a workgroup member, broke down different facets of usability before suggesting the test-case approach.

In accordance with the HITECH Act's call for revising privacy rules governing health care information, the federal government has proposed changes to HIPAA that would allow patients to learn more about who has access to their electronic health information.

HIPAA's Privacy Rule sets limits on who can access an individual's protected health information (PHI) and gives individuals a number of rights concerning that data, including the right to receive an "accounting of disclosures" from health care providers and other HIPAA-covered entities. An accounting of disclosures includes information about when PHI has been shared and for what purpose, among other things. However, under existing law, accountings do not have to include disclosures that health care providers and other covered entities make to carry out treatment, payment and health care operations (such as when a primary care physician sends a patient's medical records to a specialist for follow-up care).

The province of Ontario is contemplating the creation of electronic health records that could include a patient’s psycho-social, financial and legal history, a provincial official has indicated.

But so comprehensive and sweeping is the proposed database that privacy and legal experts say they are “appalled” and “stunned.”

The province’s plans, sketched at an e-Health conference in Toronto, Ontario earlier this month by Grant Gillis, director of ehealth standards for eHealth Ontario, would see the creation of comprehensive profiles about all Ontario patients, including their “social history.”

The records could include information about a patient’s education, employment, financial status, legal history, residence history, sexual orientation and spirituality, Gillis told the conference. Gillis also indicated that the information could include a category called “risk.” eHealth Ontario later indicated in an email that risk is a “general” category. Some examples found on forms provided by stakeholders during our engagement process include: Risk of falls/wandering; Risk of harm to others; (and) Risk of patient having perhaps been exposed to an infectious disease.”

A proposed federal rule would require hospitals, doctors' offices and health insurers to tell patients of anyone who has accessed their electronic medical records, if asked.

Under the rule proposed by the Department of Health and Human Services (HHS), health-care-related businesses must list everyone in their firms — from doctors to data-entry clerks — who has accessed a patient's electronic records and when.

"It is important to protect a person's right to know how their health information has been used or disclosed," said Rachel Seeger, spokeswoman for HHS's Office of Civil Rights.

For example, in 2008, the UCLA Medical Center fired several employees who looked at Britney Spears' medical records without being directly involved in her care. Under the new rule, Spears could see who accessed her records.